MEDICARE: SUNSET MEDICAL IMAGING, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1255983730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSET MEDICAL IMAGING, P.C.

Provider Business Mailing Address
First Line	:	78 TODT HILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	78 TODT HILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4513
Country	:	US
Telephone Number	:	347-962-2294
Fax Number	:	718-228-2639

Authorized Official
Title or Position	:	MANAGER
Name	:	ANNA LESTER
Credential	:
Telephone Number	:	347-962-2294

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	02/21/2020

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